CMS Reports 'Moderate' Number of Part B Outpatient Therapy Claims Rejected in Error

Tuesday, March 12, 2013

CMS Reports 'Moderate' Number of Part B Outpatient Therapy Claims Rejected in Error

The Centers for Medicare and
Medicaid Services (CMS) recently reported that
physical therapists and other providers who bill Medicare for outpatient
therapy services may have recently noticed an increase in the frequency of
Health Insurance Portability and Accountability Act rejection codes on their
provider notification letters. Medicare routinely mails these letters to
providers when various identified claims cannot be successfully crossed over to
their patient’s supplemental insurance companies.

The codes are:

H51000: The Procedure Code ____ is not a valid CPT or
HCPCS Code for this Date of Service

(Where
you see "_____" directly above, the value [for example, G8978;
modifier CH; or CARC 246] was reported, when applicable, on the outbound
provider notification letter that billing offices would have received.)

CMS states that the new functional
G-codes, new severity/complexity modifiers, and new Claim Adjustment Reason
Code (CARC) 246 for the January 2013 Healthcare Common Procedure Coding System
(HCPCS) and CARC updates were inadvertently not loaded. As a result, a
moderate number of Part B outpatient therapy claims (claims for physical
therapy, speech-language pathology services, and occupational therapy) were
rejected in error. The newly added severity/complexity modifiers were as
follows: CH, CI, CJ, CK, CL, CM, and CN. The new functional G-codes
fall within the following ranges:

G8978—G8999

G9158—G9176

G9186

To remedy this issue, the
Coordination of Benefits Contractor (COBC) HIPAA validation vendor added the
new G-codes to its HCPCS table as of January 28. The vendor then added the
new severity/complexity modifiers to its HCPCS table as of February
11. Lastly, the vendor added the new CARC 246 to its table as of February
25. Thus, Medicare participating therapists, physicians, and nonphysician
providers should now see a drastic
decrease in the incidence of error codes H51000, H51061-H51064, and
H51108 reflected on their provider notification letters.

If your billing office received a
provider notification letter from Medicare indicating that claims could notbe crossed over due to one of the H-series error messages described
above, there unfortunately is not
a way for Medicare to retransmit the affected claims to your patients’
supplemental insurers. Therefore, you will need to bill your patients'
supplemental insurers directly.

To help mitigate this kind of problem
in the future, CMS will implement a fail-safe strategy in advance of the
scheduled installation of new HCPCS or other code updates. This will
ensure that any incorrectly rejected Medicare crossover claims will be repaired
by all A/B Medicare Administrative Contractors, thus minimizing the impact to
the provider community.

Comments

My case load is totally wound care. How do the caps and "G" codes apply to wound care when the outcomes and goals are not functionally based?

Posted by Pamela Connor
on 3/15/2013 3:53 PM

Please help: Can an assistant write a portion of the 10th visit Progress Report. The registered clinician, of course, would do their parts and sign.

Posted by jackie
on 3/15/2013 9:10 PM

I have sent in G codes incorrectly for some medicare patients secondary to my misjudgement on which codes were to be used on first, tenth and d/c visits. Is there any way to go back and fix this issue?

Posted by Connie
on 11/20/2013 10:12 PM

H51108 '2' code is not valid line level????
what exactly does that mean?
even Availity was not quite sure of its meaning.